Reducing Major Depressive Episodes With Online Treatment
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Depression: Global prevalence, symptoms, mood, and treatment
The World Health Organization estimates that 5% of adults experience depression worldwide. Depression is different from feelings of sadness for several reasons. While sadness tends to be short-lived, depression lasts for two weeks or more and can have serious symptoms that affect a person in numerous ways. In addition, depression can significantly impair a person’s day-to-day functioning. However, there are effective treatments available, including therapy and medication.
Reducing depression and managing risk of side effects
Below, we’ll discuss major depressive episodes, online interventions to reduce depression symptoms, and ways to manage potential side effects, all aimed at improving overall well-being.
Major depressive episodes
While all major depressive episodes are a type of depression, not all depression symptoms lead to a diagnosis of a major depressive episode. Harvard Health Publishing identifies six different types of depression, including major depression. This is the most commonly recognized type of depression and is often characterized by a constant dark mood and loss of interest in activities. Other depression symptoms may include changes in sleep patterns (sleeping too much or too little), weight loss or gain, and suicidal thoughts.*
According to recent statistics from the National Institute of Mental Health, approximately 21 million adults in the U.S. experienced a major depressive episode in the past year (according to a survey in 2020). While this constitutes 8.4% of all U.S. adults, these episodes are most prevalent in those between 18 and 25; 17% of adults in this age group experienced an episode in the past year.
Despite these high numbers, one in three adults experiencing a major depressive episode did not seek treatment in the past year, yet effective treatments are available. Care can often include one or more treatments, including antidepressants, cognitive behavioral therapy (CBT), interpersonal therapy, psychodynamic counseling, or a combination.
Online CBT and incidence of major depressive episodes
Although CBT has been proven to be effective for major depressive episodes, several barriers often limit individuals from seeking this therapy. Providing CBT requires having trained professionals available to serve a community, which is not always the case, especially in smaller or more rural areas. Also, sometimes stigmas associated with mental health challenges can prevent treatment. In addition, limited time, money, and transportation can be barriers to CBT.
iCBT: Flexible treatment for reducing major depressive episodes and symptoms of depression
Internet-based cognitive-behavioral therapy (iCBT) is an increasingly popular treatment that bypasses many barriers. The virtual nature of iCBT often allows for greater flexibility, and several studies have examined its effectiveness in reducing depression symptoms in various populations or preventing its incidence altogether.
Research on mental health conditions and online interventions in reducing symptoms of depression
One study on depression in workers in Japan examined whether a specific iCBT program decreased symptoms of subthreshold depression.
Participants
Approximately 1,790 individuals were recruited from two information technology companies in Japan during 2011. Recruitment occurred through invitation emails sent by company management. Exclusion criteria included:
- Diagnosis of a major depressive episode within the past month (which was determined by using an online, self-administered version of the WHO Composite International Diagnostic Interview 3.0)
- Diagnosis of lifetime bipolar disorder
- Sick leave of 15 or more days due to personal health issues in the past three months
- Medical treatments for mental health problems within the past month
Out of the 850 individuals who opted to complete a baseline survey, 762 participants fulfilled the inclusion criteria. They were randomly placed within the intervention and control groups, with 381 in each.
The intervention
Those in the intervention group were provided a six-week, six-lesson virtual CBT program covering self-monitoring, cognitive restructuring, assertiveness, problem-solving, and relaxation. Homework was submitted voluntarily, and those who did complete the homework received feedback from trained psychologists. Five clinical psychologists provided feedback on a first-come, first-served basis as homework was submitted.
Participants in the intervention group were asked to finish the program within 10 weeks of the baseline survey. Email reminders prompted them to complete lessons and homework, but no incentives were provided. Also, company management was not informed who completed their lessons and who didn’t.
Stress management in control group and iCBT
Those in the control group received monthly emails about non-CBT stress management tips for the six months following the baseline survey. These emails covered topics such as forming healthy sleep habits and limiting alcohol intake. In addition, all employees from one of the two IT companies were provided a virtual session on stress management. After the six-month follow-up, people in the control group were given entry to the iCBT program.
Results
Among those who responded at follow-up, participants in the intervention group experienced more significant improvement in depression symptoms at three-month follow-up than participants in the control group. This study suggests that online interventions can be effective for non-clinical populations experiencing subthreshold depression symptoms.
Reducing the incidence of major depressive episodes
Reducing the incidence of major depressive episodes often involves both prevention and treatment. Ideally, the goal is to prevent many people from ever experiencing depression by offering preventive care and education. However, for those who have already experienced or currently have major depression, treatment can be used to reduce symptoms and the duration of major episodes.
Effective strategies for preventing and managing major depressive disorder
Speaking to a licensed therapist can be an important part of treating or preventing major depressive episodes. For those whose depression symptoms make it challenging to leave home, online interventions can be effective for reducing their symptoms. The methods below include both preventive measures and treatment options for major depression.
Resilience development and mental health conditions
One factor that may help prevent major depressive episodes is the development of resiliency. Resilience prepares individuals to overcome hardships in life, and those with low levels of resilience may be more prone to mental health challenges. The Center on the Developing Child at Harvard asserts that the most important factor in developing resilience is at least one stable relationship with a caring adult, such as a parent, family member, or teacher.
Cognitive behavioral therapy for major depressive disorder to minimize side effects
Cognitive behavioral therapy (CBT) can serve as an effective treatment for depressive episodes, and it can be delivered online. Many studies have examined the efficacy of internet-delivered CBT (ICBT) and found it to be effective for depression and other mental health conditions, including generalized anxiety disorder.
Family intervention for mood, mental health, and risk reduction
Family cognitive behavioral interventions, which focus on modifying negative thought patterns and behaviors within the family unit, have proven effective in addressing various mental health issues. One of the risk factors for depression is parental depression. A method that addresses depression in caregivers acts as both prevention for possible future episodes and treatment for current episodes of depression. One study found that using a family-focused method to work with children and their parents who had a history of depression reduced symptoms significantly. Per the study, “Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures.”
Takeaway
Frequently asked questions
What is required to diagnose a major depressive episode?
In order to diagnose depression, a mental health care professional must evaluate a patient using the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
The criteria for major depression, called major depressive disorder, includes having a low mood and/or anhedonia (inability to enjoy activities) in conjunction with other symptoms, such as psychomotor agitation (restlessness), unexplained physical aches, weight gain or loss, difficulty concentrating, and excessive guilt. Depressed mood and related symptoms generally must last for at least two weeks and cause clinically significant distress. For an accurate diagnosis, healthcare providers rule out other mental and physical health conditions that can cause similar symptoms.
What can trigger a depressive episode?
Several factors can contribute to an increased risk of a depressive episode. The most predominant risk factor seems to be medical history: having a previous depressive episode increases the risk of having another, and the risk compounds with each episode. Others include a family history of depression, preexisting medical conditions like heart disease or chronic pain, substance use, isolation, stressful life events, and the presence of other mood disorders.
How long does a depressive episode last?
Depressive episodes can last anywhere from a couple of weeks to several months or years. The average duration is between six months and one year. In one study around one in ten participants hadn’t recovered after three years. Getting depression treated can reduce the length of an episode and lower the risk of developing chronic major depression.
Is MDD the worst type of clinical depression?
Everyone’s experience of depression is different, even among people with the same disorder. Severe forms of major depression, seasonal affective disorder, perinatal depression or postpartum depression, and other depressive disorders can contribute to poor outcomes, including lost productivity, relationship strain, self-destructive behaviors, and suicide attempts.
How do you stop a depressive episode?
There are several medical and individual interventions that can alleviate depression symptoms:
- Talk therapy: Cognitive-behavioral therapy, dialectical behavior therapy, and acceptance and commitment therapy are a few effective therapy options for depression.
- Antidepressant medications: There are several classes of medication, such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclics, and monoamine oxidase inhibitors.
- Brain and nervous system stimulation procedures: These include vagus nerve stimulation, transcranial magnetic stimulation, and electroconvulsive therapy. They’re often used in treatment-resistant cases, or when severe symptoms need to be alleviated more quickly than other treatments allow.
- Physical activity: Even brief exercise at a moderate intensity can improve mood both short and long term, especially for mild to moderate depression.
Is MDD considered a serious mental illness?
Major depressive disorder is classified as a serious mental illness. Symptoms of severe depression such as decreased concentration and low self-worth can substantially impair someone’s ability to work, socialize, participate in leisure, care for dependents, or consistently engage in healthy behaviors.
Can MDD be cured?
There is no cure for major depression, but about half of people who experience a depressive episode will not experience another one. For those with recurrent major depressive disorder, treating depressive episodes in the and preventing depression in the future may be more realistic.
What does a depressive episode look like?
What is the deepest stage of depression?
Which behavior can trigger depressive symptoms?
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